Intertwined with cuts proposed by the governor’s Medicaid task force were an array of policies and spending decisions avidly sought by the union.

NICHOLAS CONFESSORE

In Wisconsin, public workers face a nearly unprecedented rollback of collective-bargaining rights. In New Jersey, teachers and their unions find themselves the target of open ridicule from Gov. Chris Christie, who is seeking major increases in how much the state’s public employees pay for their pensions and health care. And in Connecticut, state workers are being pressured to accept a wage freeze, more furlough days and a higher retirement age.

Yet in New York, where a fiscal crisis has helped put the state’s powerful government employee and teachers’ unions on the defensive, New York’s influential health care workers’ union appears on the verge of wringing significant victories out of Gov. Andrew M. Cuomo’s austerity budget, even as he nears potentially historic cuts in spending.

Intertwined with the hundreds of millions of dollars in cuts proposed on Thursday by Mr. Cuomo’s Medicaid task force were an array of policies and spending decisions avidly sought by the union, 1199 S.E.I.U. United Healthcare Workers East. They included a wage floor for home health workers; substantial rollbacks in Mr. Cuomo’s proposed cuts to nursing homes and personal care; and a major overhaul of the home care industry that is likely to boost the union’s membership over the long term.

Those victories have left some other health care industry players grumbling — and may suggest a model for other unions seeking to ride out the twin storms of a skeptical public and plunging revenues.

“We are proud that working people were able to play a role in proposing innovative solutions and thoughtful reforms that protect patient care,” George Gresham, the union’s president, said in a statement. “Delivering state savings without disruption to Medicaid beneficiaries and their caregivers is an enormous feat. While many challenges still lie ahead, when working people are given a seat at the table, a lot can be achieved.”

The difference between New York and other states stems in part from the political environment. Wisconsin and New Jersey have Republican governors, while Mr. Cuomo is a Democrat who has maintained close ties to labor even while pledging to roll back public unions’ influence over government spending. And the union benefited from Mr. Cuomo’s decision to invite the industry’s biggest players, including it, to join the task force to hash out cuts with his administration, rather than fighting with them in public.

But the union’s success follows a carefully plotted two-year-long strategic retreat intended to minimize the momentum for cuts and channel the debate into policies that would best suit its members.

In 2009, amid the Wall Street crash, the union used planned pay raises to shore up its workers’ wobbly health and pension funds, a move that sharply contrasted with the hard line that other unions took a year later when Gov. David A. Paterson asked for further concessions.

The union also sought to get ahead of Mr. Cuomo’s cuts rhetorically as well as substantively. Mr. Gresham has taken a noticeably softer line against Mr. Cuomo’s call for cuts than some of his partners in labor — like the state teachers’ union — and 1199 had made clear for months that it expected substantial cuts this year.

“We could read the handwriting on the wall, and we wanted to do cuts in a smart way,” said Kevin Finnegan, the union’s political director. “This was a good opportunity to have a say.”

Well before last year’s election, 1199 began advocating changes to programs for home health care, a rapidly expanding category of Medicaid spending and an industry that also happens to be less unionized than other sectors, like hospitals and nursing homes.

The Medicaid team’s proposals largely mirror the union’s original aims, moving home health services into managed-care programs while driving business toward nonprofit home health agencies. While officials project that the shift will save the state money by controlling costs, it is also likely to bring more home health workers into 1199’s fold.

“They got two seats at the table and accolades,” said Joanne Cunningham, president of the Home Care Association of New York, an industry trade association that did not have a representative on the Medicaid team. “They got their living wage. As far as the process, if you didn’t get to sit at the table, it was the equivalent of being out in the nosebleeds.”

And 1199 quietly joined with the New York City teachers’ union, the United Federation of Teachers, in a grass-roots effort to persuade lawmakers to extend a state income tax surcharge on high-income taxpayers. That has allowed the union to push in recent weeks for more money to offset potential cuts, but without directly attacking Mr. Cuomo.

The committee’s recommendations included several measures that would cut costs for hospitals or raise additional revenue for the state, which critics said amounted to a less-than-subtle effort to offset the cuts to the big players that Mr. Cuomo wanted to win over.

Never miss a story

Choose the plan that's right for you.
Digital access or digital and print delivery.